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14 <br /> f+ A Environmental Health Department N �k:J OAQ U I N jo sz PvAe <br /> j tr � h' 1 ._.__ COUNTY - - - - - <br /> 0%1�r;, Greatness grows here . <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report , HSC 25404 . 1 . 2(c) ( 1 ) <br /> All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any <br /> violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report , HSC 25185(c) (3) <br /> Note : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate , <br /> For this certification to be complete , the operator of the site must include : <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : May 17 , 2021 Inspected By : CAROL PRESTO <br /> Facility Address : 4075 E MAIN ST , STOCKTON CERS ID : 10180873 <br /> I certify under penalty of law that : <br /> 1 . I have corrected the violations specified in the Inspection Report from the above- mentioned inspection date . <br /> 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , and complete : <br /> Photos Paperwork C*e. Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> Name : sNan S�2e (. Title : 'i�CI014 <br /> Signature : ADate : 5l N7 � 1 <br /> ux <br /> , N ' laa �� � ol ► . Nr � ► t► cf�t�T1 ► <br /> i) V� j) AK(1_ N1ENT <br />